Paul Slosar, MD, president of SpineCare Medical Group in Daly City, Calif., discusses three big trends for 2018, covering technology, business challenges and the best opportunities for spine surgeons this year.

1. The most important spine technology trend for 2018: The focus is now on surface technologies for fusion implants. The most sophisticated and advanced surface has a unique titanium nano-technology to stimulate the host bone to grow rapidly, promoting early osseous-integration. This should lower surgeons' dependence on expensive or inflammatory biologics. The porous implants may be better than smooth surfaces, but still lag behind in terms of stimulating a cellular response.

2. Key clinical or business challenges spine surgeons will face this year: The challenges to the remaining independent spine practices persist. Large multispecialty groups and hospital systems continue to grow and erode market share opportunities for the smaller practices. Ongoing insurance company denials appear to be escalating, challenging physicians (and our patients) with denials for even the most basic tests and treatments (MRI/ injections/ PT). With patients (the insurer's customers) now responsible for enormous out-of-pocket deductibles, it seems incongruous that the payers would be routinely denying these simple upstream care items.

3. Best opportunity for spine surgeons in 2018: Although it's been on the radar for several years, this may be the year that bundled payment models finally hit their stride. While CMS has adopted a more voluntary posture toward participation, that hasn't discouraged interest in their BPCI program, now entering its third year. Commercial payers are following and, in 2018, some will begin with small, selective networks of spine specialists to grow their own risk-sharing programs.